Report finds NHS chairs and non-executives more white and more male – it is ‘a wake up call for the health service’

Joan Saddler

The chairs and non-executive directors on boards that run NHS organisations in England have become less diverse over the last 15 years, with fewer people of black and minority ethnicity (BME) and women occupying the positions.

A report from the NHS Confederation calls for a review of the current appointments process after it found that the percentage of chairs and non-executives of NHS Trusts from a BME background has nearly halved in the last decade – from 15 per cent in April 2010 to 8 per cent today.

The report also points out that the percentage of women in chair and non-executive roles has fallen from 47 per cent in 2002 to 38 per cent now.

At the same time there has been no increase in the proportion of non-executive leaders with a disability – this has remained static, between 5 and 6 per cent.

The report highlights two factors that may have had an impact on Board diversity.

The first was the abolition of the NHS Appointments Commission in 2012. The Commission oversaw appointments to a range of NHS public bodies and brought a degree of rigour and consistency to the recruitment of senior leaders. It was never replaced although NHS Improvement does have some limited influence over some chair appointments to NHS foundation trusts.

The second was the creation of foundation trusts in the mid-2000s. From the outset, foundation trusts were conceived as independent public benefit organisations, which meant any appointments to their boards would not be considered public appointments. Although overseen by elected Boards of Governors at local level, non-executive appointments made by foundation trusts are therefore not subject to further scrutiny and oversight.

Joan Saddler, Director of Partnerships and Equality at the NHS Confederation and co-chair of the NHS Equality and Diversity Council, said: “This report must be a wake-up call for a health service which is heading in the wrong direction and becoming less diverse at board level. That is not right for patients and staff working in NHS organisations.

“We support the autonomy of foundation trusts but we must find a way of developing inclusive top teams that provide example and leadership, and set expectations throughout their organisations. Chairs and non-executives heading NHS organisations must be accountable to and representative of the communities they serve and the staff for whom they are responsible. It is about fairness but also simply about good governance and improving the quality of patient care and engagement - and it needs to start at the top.

“We acknowledge that efforts are being made by NHS England/NHS Improvement to address this deficit, particularly among executive board members, but we are yet to see more progress when it comes to chair and non-executive appointments.”

Danielle Oum, chair of Walsall Healthcare NHS Trust and co-chair of the NHS Confederation’s BME Leadership Network, said: “Diversity on boards is important for diversity of thought and the avoidance of group think. It’s particularly key for the NHS due to the make-up of its workforce and the population it serves.

“History has shown that when there is structural change in the NHS, diversity of leadership reduces – we need to avoid that legacy in the development of integrated care organisations and associated reconfigurations.”

Ifti Majid, chief executive of Derbyshire Healthcare NHS Foundation Trust and co-chair of the BME Leadership Network, said: “At the heart of the role of boards is improving health outcomes for local people and we know boards that are representative of local communities are more able to achieve that.

“Having the confidence of local people is essential to this task and if local people don’t recognise their views, beliefs and cultures around our board tables that confidence will not form.

“The time for passively accepting inequality has long passed - as boards and senior leaders we must actively seek difference and be creative about how we look to be inclusive as without this we will make decisions that are not well informed.”

The report has been written by former Barking, Havering and Redbridge University Hospitals NHS Trust chair Maureen Dalziel. It makes a number of recommendations, including: 

  • chairs of NHS England and NHS Improvement appoint a lead chair to work with the NHS Confederation to make recommendations to ministers for addressing the diversity deficit in NHS boards.
  • a review of recruitment search firms takes place to ensure they are incentivised and can provide diverse shortlists for NHS organisations.
  • the NHS Leadership Academy and Regional Talent Boards should expand their role to include development and support for chairs and non-executives on governance and equality, diversity and inclusion.

 NHS England/NHS Improvement are running programmes to address this issue, including the Workforce Race Equality Standard, which is now part of the NHS Long Term Plan.

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